Bipolar psychiatric disorder (BD) -- which is characterized by "…cycles of depression and mania" -- is a "euphoric, high-energy state" that can produce remarkable bursts of creativity or, on the other hand, can produce erratic behavioral events that are risky and provocative (Gardner, 2011). About 2.4% of the world's population has been diagnosed with bipolar disorder (at one time or another in their lifetime) but the rate in the United States (4.4% of the population) is the highest of any nation (Gardner, p. 1). The lowest rate on record is in India, 0.1%. This paper reviews various aspects and ramifications of the effects of bipolar disorder through nine peer-reviewed research articles.

Bipolar disorder and cigarette smoking

In the journal Bipolar Disorders the authors point out that adults suffering from bipolar disorder are "…two to three times more likely" have begun a serious smoking habit, which is a "devastating addiction" and is very difficult to end for the BD patient (Heffner, et al., 2011). The authors conducted a search for peer-reviewed articles on bipolar disorder and tobacco; they found 262 such articles but only 13 were relevant. In those thirteen articles (most published after 2004) a number of important facts were revealed. For example, adolescents with BD are far more likely to start smoking than the peers who do not have any psychiatric disorder (22% vs. 4%) (Heffner, 440). Eighty percent of those individuals with PD who smoke tobacco continue to smoke for a lifetime while just 40% of those without psychiatric disorders who smoke are users for their lifetimes (Heffner, 440).

As to the reasons why bipolar disorder tends to bring on the smoking habit, and keep it locked in, there are several: a) nicotine has the capacity to "enhance cognitive functioning, including attention"; this is in effect a self-medicating situation; b) medications prescribed for bipolar sufferers ("certain antipsychotics and antiepileptics") tend to "enhance the risk" of becoming a dependent smoker; and c) smoking cessation can cause episodes of mania (Heffner, 442). In fact on page 443 of this article the authors explain that dangerous side effects have been reported when a bipolar patient quits ("seizures, sedation, and worsening of psychiatric symptoms") (Heffner).

Treatment for alcoholism in bipolar disorder patients

Heavy tobacco use isn't the only substance dependence that a bipolar patient may be addicted to. In the peer-reviewed American Journal on Addictions the authors explain that there is a very high "prevalence rate of alcohol abuse/dependency" among bipolar patients, however notwithstanding the epidemiological research that has been conducted, little has been done in terms of studying the results of alcohol treatment programs for bipolar patients (Hall-Flavin, et al., 2010).

Given that the authors assert there is a "high prevalence rate" of alcohol dependency among individuals with bipolar disorder, why are there so few bipolar patients seeking help with alcohol addiction? The authors suggest several reasons, including the fact that there are a limited number of chemical dependency treatment programs. Also, chemical dependency treatment programs generally require "…a degree of behavioral stabilization" and hence, a bipolar person may not qualify because clearly bipolar disorder creates an unstable situation (Hall-Flavin, 41). Moreover, individuals with "undiagnosed, untreated," or only partially treated bipolar symptoms are possibly not as motivated to seek treatment for alcoholic addiction (Hall-Flavin, 41).

It is also possible that notwithstanding dependence on alcohol, a bipolar patient may not even realize that he or she needs treatment; in two surveys (of 3,305 and 7,009 bipolar patients) less than 10% of those responding to the surveys "…even perceived a need for treatment" (Hall-Flavin, 43). The research Hall-Flavin and colleagues conducted shows that women have a higher degree of "vulnerability" to binge drinking than males; and as to why bipolar women need more drinks to reach the level they desire than men, the authors are not certain. But there is evidence that women with bipolar disorder who are also addicted to alcohol have "…higher lifetime rates of posttraumatic stress disorder" than bipolar women that are not alcohol dependent (Hall-Flavin, 43). This could indicate that the increased intake of alcohol in addicted bipolar women may be an attempt to "…numb trauma or decrease anxiety" created by the posttraumatic stress condition (Hall-Flavin, 43).

Marijuana, tobacco, alcohol and the association with bipolar disorder

Heffner and colleagues published another article (a year after the previously reviewed article) that concluded with the report that while smoking cigarettes did not "predict a worse course" of bipolar disorder, smoking has been linked to "…an increased risk of developing alcohol and cannabis use disorders" among adolescents (Heffner, 2012, 99). This research was conducted by the University of Cincinnati on 80 adolescents (under the age of 18) and 81 adults that had been hospitalized for a manic episode, and were surveyed 12 months following the hospitalization.

The hypothesis put forward -- that smoking tobacco would "predict poorer recovery" in the 12 months subsequent to hospitalization and would cause the patient to abuse alcohol and marijuana and might try suicide -- was verified to some degree by the researchers. In the year since initial hospitalization, 28% (20) of the adolescents were hospitalized again and 14% tried suicide (Heffner, 104). But the adolescents who had smoked at the launch of the study were no more likely than those who didn't smoke to "report subsequent hospitalization" (Heffner, 104). As to the adults in this survey, 9 (22%) were hospitalized again and one adult attempted suicide. Meanwhile 13% (9) of the adolescents acquired a cannabis habit in the year after hospitalization and eight of those 9 adolescents also acquired a heavy alcohol consumption habit (Heffner, 104).

So while smoking cigarettes at "baseline" correctly predicted the increased chances of adolescents getting heavily involved in marijuana and alcohol, smoking in this research was not linked to "poorer recovery" per se following the first episode of mania (and hospitalization for that episode) (Heffner, 106).

Suicide and self-mutilation in bipolar disorder

Along with alcohol and tobacco-related dependencies, a scholarly article in the Australian and New Zealand Journal of Psychiatry points out that suicide and self-mutilation are also issues associated with bipolar disorder. Self-mutilation (cutting wrists, arms, legs, etc.) and suicide have been known to be common among people with "borderline personality disorder" (Joyce, et al., 2010). In this article, the authors conducted a study using "adult probands" (probands are persons serving as the beginning point of a research project involving family) that had been previously treated for depression and agreed to participate in a family study of depression (Joyce, 251).

The study continued with a total of 214 probands and 407 "first-degree relatives" -- all of whom were asked to complete a survey (with 240 items utilizing a 5-point Likert scale version of the TCI). Those that completed the surveys were also screened for personality traits and the results of the survey and screenings were entered into a database for analysis. The results showed that for probands that had major depressive issues and had attempted suicide -- compared with probands' relatives with depressive disorders that had not attempted suicide -- their relatives had "…comparable rates of mood disorders and suicide attempts" (Joyce, 254). The same was true for relatives of probands with bipolar disorder that had a history of self-mutilation (compared with relatives of bipolar probands that had not mutilated themselves); the results showed that relatives of bipolar probands that had mutilated themselves also had higher rates of self-mutilation (Joyce, 254). The point here is clearly that depressive disorders like bipolar disorder tend to run in the family, and moreover the negative behaviors associated with bipolar disorder can be seen in close family members of bipolar patients.

Children of bipolar patients are more likely to suffer mental disorders

Along the same theme as the Joyce article, authors Gershon Samuel and Jair Soares report that children of parents with bipolar disorder are "…2.7 times more likely to develop any mental disorder" than are the children of parents who have normal health in a psychological sense (Samuel, et al., 2000). The authors base their assertions on the review of 17 scholarly studies previously published on this subject. They go on to explain that children of bipolar parents are 4 times more likely to "…develop an affective disorder than offspring of normal parents" (Samuel, 465).

In fact children of bipolar parents are known to suffer from "…disruptive behavior disorders, including ADHD, and anxiety disorders" (Samuel, 466). Echoing -- and yet expanding -- the findings of Joyce and colleagues, Samuel reports (466) that bipolar and depressive disorders occurred "…more frequently in the relatives" of bipolar adolescents compared with the relatives of adult probands with bipolar disorders (466).

Criminality is the main topic in another research article in the journal Bipolar Disorders, a piece that points to the fact that criminal behavior by those suffering from bipolar disorder could be related to "substance use disorders" and other conditions related to "impulsivity" (Swann, 2011). In this research, the authors recruited 112 individuals with bipolar disorder, and of those,…[continue]